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1.
Health Res Policy Syst ; 19(Suppl 1): 49, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882956

RESUMO

BACKGROUND: Self-care interventions offer a solution to support the achievement of three goals of the World Health Organization (WHO): to improve universal health coverage, reach people in humanitarian situations, and improve health and well-being. In light of implementing WHO consolidated guidelines on self-care interventions to strengthen sexual and reproductive health (SRH) in the Eastern Mediterranean Region (EMR), especially during the COVID-19 pandemic, pharmacists from four different EMR countries discussed the current SRH situation, inequality gaps, barriers to SRH service access and the pharmacist's crucial role as a first-line responder to patients before, during and after COVID-19. CASE PRESENTATION: Self-care interventions for SRH allow health care providers to serve a greater number of patients, improve progress toward universal health coverage, and reach people in humanitarian crises. In fact, these interventions can be significantly enhanced by utilizing community pharmacists as first-line health care providers. This review highlights the important role of community pharmacists in promoting self-care interventions and empowering individuals, families and communities. As a result, well-informed individuals will be authoritative in their health decisions. Exploring self-care interventions in the EMR was done through reviewing selected SRH services delivery through community pharmacists before and during the COVID-19 pandemic in Egypt, Jordan, Lebanon and Somalia. Before the COVID-19 pandemic, community pharmacists were found to be excluded from both governmental and nongovernmental SRH programmes. During the pandemic, community pharmacists managed to support patients with self-care interventions, whether voluntarily or through their pharmacy associations. This highlights the need for the health care decision-makers to involve and support community pharmacists in influencing policies and promoting self-care interventions. CONCLUSION: Self-care interventions can increase individuals' choice and autonomy over SRH. Supporting community pharmacists will definitely strengthen SRH in the EMR and may help make the health system more efficient and more targeted.


Assuntos
Acesso aos Serviços de Saúde , Pandemias , Farmacêuticos , Saúde Reprodutiva , Autocuidado , Saúde Sexual , Tomada de Decisões , Difusão de Inovações , Egito , Feminino , Serviços de Saúde , Humanos , Jordânia , Líbano , Masculino , Região do Mediterrâneo , Papel Profissional , Serviços de Saúde Reprodutiva , Somália
2.
Health Res Policy Syst ; 19(Suppl 1): 45, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882960

RESUMO

Innovative people-centered care modalities including self-care interventions offer an opportunity to ensure continuity of healthcare services during COVID-19 and in post-COVID-19, as well as contribute to the achievement of universal health coverage. Parliamentarians are uniquely positioned to promote self-care interventions for sexual and reproductive health and rights through their legislative, budget allocation, oversight, and advocacy roles. However, existing health systems governance challenges in the Eastern Mediterranean region such as weak institutions setups, fragmentation of health programs, and limitation of resources could impede parliamentarians' progress. To address these challenges, the following recommended actions should be considered: (1) promote the adaptation of sexual and reproductive health and rights service packages at primary healthcare level to integrate self-care interventions (2) govern innovative people-centered care channels including self-care interventions; and (3) engage in a dialogue with civil society and communities to meet needs, raise public awareness and generate demand.


Assuntos
Acesso aos Serviços de Saúde , Serviços de Saúde , Pandemias , Saúde Reprodutiva , Autocuidado , Saúde Sexual , Comunicação , Difusão de Inovações , Governo , Recursos em Saúde , Direitos Humanos , Humanos , Liderança , Região do Mediterrâneo , Atenção Primária à Saúde , Serviços de Saúde Reprodutiva
4.
Lima; Perú. Ministerio de Salud; 20210300. 21 p. tab.
Monografia em Espanhol | MINSAPERÚ | ID: biblio-1151999

RESUMO

El documento contiene las medidas técnicas, administrativas y procedimientos para acceder a los servicios de salud sexual y reproductiva, en el marco de la emergencia sanitaria por la COVID-19.


Assuntos
Atenção , Pesos e Medidas , Registros , Infecções por Coronavirus , Técnicas , Serviços de Saúde Reprodutiva
5.
Reprod Health ; 18(1): 47, 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33622376

RESUMO

BACKGROUND: Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. METHODS: This study utilizes cross-sectional health facility (N = 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N = 1479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Component Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). RESULTS: Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. CONCLUSION: Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that using more nuanced measures of integration may (a) more accurately reflect true variation in integration within and across health facilities, (b) enable more precise measurement of the determinants or effects of integration, and (c) provide more tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.


Assuntos
Prestação Integrada de Cuidados de Saúde , Serviços de Planejamento Familiar , Administração de Instituições de Saúde , Programas de Imunização , Serviços de Saúde Reprodutiva , Adulto , Criança , Pré-Escolar , Estudos Transversais , Prestação Integrada de Cuidados de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/normas , Serviços de Planejamento Familiar/organização & administração , Serviços de Planejamento Familiar/normas , Serviços de Planejamento Familiar/provisão & distribução , Feminino , Instalações de Saúde/normas , Administração de Instituições de Saúde/métodos , Administração de Instituições de Saúde/normas , Indicadores Básicos de Saúde , Humanos , Programas de Imunização/organização & administração , Programas de Imunização/normas , Programas de Imunização/provisão & distribução , Lactente , Recém-Nascido , Masculino , Nigéria/epidemiologia , Gravidez , Saúde Reprodutiva/normas , Serviços de Saúde Reprodutiva/organização & administração , Serviços de Saúde Reprodutiva/normas , Serviços de Saúde Reprodutiva/provisão & distribução , Inquéritos e Questionários , População Urbana/estatística & dados numéricos , Vacinação/métodos , Vacinação/estatística & dados numéricos
6.
Artigo em Inglês | MEDLINE | ID: mdl-33572337

RESUMO

Despite at times having greater needs for sexual and reproductive health (SRH) services, adolescents with disabilities often face challenges when trying to access them. This inaccessibility is further exacerbated during female adolescence. The qualitative study examines how SRH services respond to the characteristics of Tanzanian adolescent females with disabilities. We used the method of empathy-based stories to investigate the perceptions of 136 adolescent females with disabilities of their access to SRH services in Tanzania. The study used thematic content analysis and the Levesque model of health care access was applied as an analytical framework. The results demonstrate that discrimination affects access at different phases of care-seeking, that affectionate behaviour of providers is a central enabler of access, and that for this population access relies on a collective effort. We propose that affection, as an enabler of access, is as an additional provider dimension of access to SRH services for adolescents with disabilities, serving as a "reasonable accommodation" to the health care systems in southern contexts and beyond.


Assuntos
Pessoas com Deficiência , Serviços de Saúde Reprodutiva , Adolescente , Feminino , Acesso aos Serviços de Saúde , Humanos , Saúde Reprodutiva , Comportamento Sexual , Tanzânia
7.
BMC Public Health ; 21(1): 276, 2021 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-33536001

RESUMO

BACKGROUND: Policymakers and health professionals prefer to use summarized evidence of practice recommendations. The aim of this scoping review is therefore to identify available guidelines, consensus statements, the standard of practice, and practice recommendations on reproductive health service provision during the COVID-19 pandemics. METHODS: We searched guideline databases and websites of professional associations and international organizations working on sexual and reproductive health. We looked for practice recommendations on sexual reproductive health services (SRH) during COVID-19 pandemics. Additionally, we searched: MEDLINE, EMBASE, and Google Scholar. Data extraction was done by two independent reviewers using a customized tool that was developed to record the key information of the source that's relevant to the review question. The difference between the two authors on data extraction was resolved by discussion. RESULTS: A total of 21 records were included in the review. Identified recommendations were classified into thematic areas. The records addressed approaches to antenatal care, labour and delivery, postnatal care, safe abortion, contraception, gender-based violence, and artificial reproduction. CONCLUSIONS: There were consistent consensus statements and recommendations that there should be access to sexual and reproductive health services like antenatal care (ANC), postnatal care (PNC), contraception service, safe abortion care, and clinical management of rape survivors during the COVID-19 pandemics with the concerted effort of service re-organization. The practice recommendations focus on innovative ways of service provision to minimize patient and staff exposure to COVID-19 as well as alleviate the burden on the health care system. These include utilizing telemedicine and community/home-based care or self-care.


Assuntos
Serviços de Saúde Reprodutiva , Consenso , Humanos , Guias de Prática Clínica como Assunto
8.
Artigo em Inglês | MEDLINE | ID: mdl-33477290

RESUMO

Background: In low-income countries such as Benin, most people have poor access to healthcare services. There is scarcity of evidence about barriers to accessing healthcare services in Benin. Therefore, we examined the magnitude of the problem of access to healthcare services and its associated factors. Methods: We utilized data from the 2017-2018 Benin Demographic and Health Survey (n = 15,928). We examined the associations between the demographic and socioeconomic characteristics of women using multilevel logistic regression. The outcome variable for the study was problem of access to healthcare service. Adjusted odds ratios (AORs) with 95% confidence intervals (95% CI) were estimated. Results: Overall, 60.4% of surveyed women had problems in accessing healthcare services. Partner's education (AOR = 0.70; 95% CI; 0.55-0.89), economic status (AOR = 0.59; 95% CI; 0.47-0.73), marital status (AOR = 0.44; 95% CI; 0.39-0.51), and parity (AOR = 1.85; 95% CI; 1.45-2.35) were significant individual-level factors associated with problem of access to healthcare. Region (AOR = 5.24; 95% CI; 3.18-8.64) and community literacy level (AOR = 0.69; 95% CI; 0.51-0.94) were the main community-level risk factors. Conclusions: Enhancing husband education through adult education programs, economic empowerment of women, enhancing national education coverage, and providing priority for unmarried and multipara women need to be considered. Additionally, there is the need to ensure equity-based access to healthcare services across regions.


Assuntos
Assistência à Saúde/organização & administração , Acesso aos Serviços de Saúde , Serviços de Saúde Reprodutiva/organização & administração , Adulto , Atitude Frente a Saúde , Teorema de Bayes , Benin , Feminino , Pesquisas sobre Serviços de Saúde , Instalações de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde , Humanos , Análise Multinível , Gravidez , Fatores Socioeconômicos
9.
JMIR Mhealth Uhealth ; 9(1): e19109, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33448930

RESUMO

BACKGROUND: Digital health usability assessments can help explain how well mobile health (mHealth) apps targeting young people with sexual and reproductive health (SRH) information performed and whether the intended purpose was achieved. However, few digital health assessments have been conducted to evaluate young people's perceptions regarding mHealth system interactions and content relevance on a wide range of SRH topics. In addition, the majority of randomized controlled trials (RCTs) have focused on push messaging platforms; therefore, the mHealth field lacks sufficient RCTs investigating on-demand mHealth SRH platforms. OBJECTIVE: The objective of this study was to explore young people's experiences using an on-demand SRH mHealth platform in Kenya. METHODS: We used qualitative data related to the usability of an mHealth platform, Adolescent/Youth Reproductive Mobile Access and Delivery Initiatives for Love and Life Outcome (ARMADILLO), collected at the end of the intervention period. A total of 30 in-depth interviews (IDIs) were held with the intervention participants (15 women and 15 men) to elicit their experiences, opinions, and perspectives on the design and content of the ARMADILLO platform. The study participants were randomly selected from a list of intervention arm participants to participate in the IDIs. The interviews were later transcribed verbatim, translated into English, and coded and analyzed thematically using NVivo version 12 software (QSR International). RESULTS: Respondents reported varied user experiences and levels of satisfaction, ranging from ease of use by the majority of the respondents to systematic frustrations that prevented some participants from progressing to other stages. Interesting features of the mHealth platform included the immediate response participants received when requesting messages, weekly remunerated quizzes, and perceived ability of educative and informative content and messages to change behaviors. Proposed enhancements to the platform included revising some concepts and words for easy understanding and increasing the interactivity of the platform, whereby young people could seek clarity when they came across difficult terms or had additional questions about the information they received. CONCLUSIONS: The importance of understanding the range of health literacy and technological variations when dealing with young people cannot be overemphasized. Young people, as mHealth end users, must be considered throughout intervention development to achieve optimum functionality. In addition, young people targeted with mHealth SRH interventions must be sensitized to the interactions on mHealth platforms or any other digital health apps if implemented in a nonresearch setting for optimal use by the targeted audience.


Assuntos
Telefone Celular , Saúde Reprodutiva , Telemedicina , Envio de Mensagens de Texto , Adolescente , Adulto , Assistência à Saúde , Feminino , Humanos , Entrevistas como Assunto , Quênia , Masculino , Pesquisa Qualitativa , Serviços de Saúde Reprodutiva/organização & administração , Adulto Jovem
10.
Obstet Gynecol ; 137(2): 225-233, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33416284

RESUMO

Racial and ethnic disparities in women's health have existed for decades, despite efforts to strengthen women's reproductive health access and utilization. Recent guidance by the American College of Obstetricians and Gynecologists (ACOG) underscores the often unacknowledged and unmeasured role of racial bias and systemic racial injustice in reproductive health disparities and highlights a renewed commitment to eliminating them. Reaching health equity requires an understanding of current racial-ethnic gaps in reproductive health and a concerted effort to develop and implement strategies to close gaps. We summarized national data for several reproductive health measures, such as contraceptive use, Pap tests, mammograms, maternal mortality, and unintended pregnancies, by race-ethnicity to inform health-equity strategies. Studies were retrieved by systematically searching the PubMed (2010-2020) electronic database to identify most recently published national estimates by race-ethnicity (non-Hispanic Black or African American, Hispanic or Latinx, and non-Hispanic White women). Disparities were found in each reproductive health category. We describe relevant components of the Affordable Care Act (ACA) and the Preventing Maternal Deaths Act, which can help to further strengthen reproductive health care, close gaps in services and outcomes, and decrease racial-ethnic reproductive health disparities. Owing to continued diminishment of certain components of the ACA, to optimally reach reproductive health equity, comprehensive health insurance coverage is vital. Strengthening policy-level strategies, along with ACOG's heightened commitment to eliminating racial disparities in women's health by confronting bias and racism, can strengthen actions toward reproductive health equity.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Serviços de Saúde Reprodutiva , Acesso aos Serviços de Saúde , Humanos , Resultado do Tratamento
14.
PLoS One ; 15(12): e0242046, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33347460

RESUMO

INTRODUCTION: Delivering integrated sexual and reproductive health services (SRHS) in emergencies is important in order to save lives of the most vulnerable as well as to combat poverty, reduce inequities and social injustice. More than 60% of preventable maternal deaths occur in conflict areas and especially among the internally displaced persons (IDP). Between 2016 and 2018, unprecedented violence erupted in the Kasaï's region, in the Democratic Republic of Congo (DRC), called the Kamuina Nsapu Insurgency. During that period, an estimated three million of adolescent girls and women were forced to flee; and have faced growing threat to their health, safety, security, and well-being including significant sexual and reproductive health challenges. Between August 2016 and May 2017, the "Sous-Cluster sur les violences basées sur le genre (SC-VBG)" in DRC (2017) reported 1,429 Gender Based Violence (GBV) incidents in the 49 service delivery points in the provinces of Kasaï, Kasaï Central and Kasaï Oriental. Rape cases represented 79% of reported incidents whereas sexual assault and forced marriage accounted for respectively 11% and 4% of Gender Based Violence (GBV) among women and adolescent girls. This study aims to assess the availability of SRHS in the displaced camps in Kasaï; to evaluate the SRHS needs of young girls and women in the reproductive age (12-49). Studies of sexual and reproductive health (SRH) in the Democratic Republic of Congo (DRC) have often included adolescent girls under the age of 15 because of high prevalence of child marriage and early onset of childbearing, especially in the humanitarian context. According to the 2013 Demographic and Health Survey (DHS), about 16% of surveyed women got married by age 14 while the prevalence of early child marriage (marriage by 15) was estimated at 30%; to assess the use of SRHS services and identify barriers as well as challenges for SRH service delivery and use. Findings from this study will help provide evidence to inform towards more needs-based and responsive SRH service delivery. This is hoped for ultimately improve the quality and effectiveness of services, when considering service delivery and response in humanitarian settings. DATA AND METHODS: We will conduct a mixed-methods study design, which will combine quantitative and qualitative approaches. Based on the estimation of the sample size, quantitative data will be drawn from the community-based survey (500 women of reproductive age per site) and health facility assessments will include assessments of 45 health facilities and 135 health providers' interviews. Qualitative data will comprise materials from 30 Key Informant Interviews (KII) and 24 Focus Group Discussions (FGDs), which are believed to achieve the needed saturation levels. Data analysis will include thematic and content analysis for the KIIs and FGDs using ATLAS.ti software for the qualitative arm. For the quantitative arm, data analysis will combine frequency and bivariate chi-square analysis, coupled with multi-level regression models, using Stata 15 software. Statistic differences will be established at the significance level of 0.05. We submitted this protocol to the national ethical committee of the ministry of health in September 2019 and it was approved in January 2020. It needs further approval from the Scientific Oversee Committee (SOC) and the Provincial Ministry of Health. Prior to data collection, informed consents will be obtained from all respondents.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Refugiados/psicologia , Serviços de Saúde Reprodutiva/organização & administração , Saúde da Mulher , Adolescente , Adulto , Criança , República Democrática do Congo , Feminino , Humanos , Pessoa de Meia-Idade , Saúde Reprodutiva , Saúde Sexual , Adulto Jovem
15.
Int Perspect Sex Reprod Health ; 46(Suppl 1): 83-89, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33326403

RESUMO

COVID-19 has compromised and disrupted sexual and reproductive health (SRH) across multiple dimensions: individual-level access, health systems functioning, and at the policy and governance levels. Disruptions to supply chains, lockdown measures and travel restrictions, and overburdened health systems have particularly affected abortion access and service provision. The pandemic, rather than causing new issues, has heightened and exposed existing fractures and fissures within abortion access and provision. In this viewpoint, we draw on the concept of "structural violence" to make visible the contributing causes of these ruptures and their inequitable impact among different groups.


Assuntos
Aborto Induzido/psicologia , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Racismo/psicologia , Serviços de Saúde Reprodutiva , Feminino , Humanos , Pandemias , Política , Gravidez , Determinantes Sociais da Saúde , Violência
16.
JAMA Netw Open ; 3(12): e2030214, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33337495

RESUMO

Importance: Sexual and reproductive health services are a primary reason for care seeking by female young adults, but the association of the 2010 Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE) with insurance use for these services has not been studied to our knowledge. Insurer billing practices may compromise dependent confidentiality, potentially discouraging dependents from using insurance or obtaining care. Objective: To evaluate the association between implementation of ACA-DCE and insurance use for confidential sexual and reproductive health services by female young adults newly eligible for parental coverage. Design, Setting, and Participants: For this cross-sectional study, a difference-in-differences analysis of a US national sample of commercial claims from January 1, 2007, to December 31, 2009, and January 1, 2011, to December 31, 2016, captured insurance use before and after policy implementation among female young adults aged 23 to 25 years (treatment group) who were eligible for dependent coverage compared with those aged 27 to 29 years (comparison group) who were ineligible for dependent coverage. Data were analyzed from January 2019 to February 2020. Exposures: Eligibility for parental coverage under the ACA-DCE as of 2010. Main Outcomes and Measures: Probability of insurance use for contraception and Papanicolaou testing. Emergency department and well visits were included as control outcomes not sensitive to confidentiality concerns. Linear probability models adjusted for age, plan type, annual deductible, comorbidities, and state and year fixed effects, with SEs clustered at the state level. Results: The study sample included 4 690 699 individuals (7 268 372 person-years), with 2 898 275 in the treatment group (mean [SD] age, 23.7 [0.8] years) and 1 792 424 in the comparison group (mean [SD] age; 27.9 [0.8] years). Enrollees in the treatment group were less likely to have a comorbidity (77.3% vs 72.9%) and more likely to have a high deductible plan (14.6% vs 10.1%) than enrollees in the comparison group. Implementation of the ACA-DCE was associated with a -2.9 (95% CI, -3.4 to -2.4) percentage point relative reduction in insurance use for contraception and a -3.4 (95% CI, -3.9 to -3.0) percentage point relative reduction in Papanicolaou testing in the treatment vs comparison groups. Emergency department and well visits increased 0.4 (95% CI, 0.2-0.7) and 1.7 (95% CI, 1.3-2.1) percentage points, respectively. Conclusions and Relevance: The findings suggest that implementation of the ACA-DCE was associated with a reduction in insurance use for sexual and reproductive health services and an increase in emergency department and well health visits by female young adults newly eligible for parental coverage. Some young people who gained coverage under the expansion may not be using essential, confidential services.


Assuntos
Cobertura do Seguro/tendências , Seguro Saúde , Serviços de Saúde Reprodutiva , Saúde Sexual , Serviços de Saúde da Mulher , Anticoncepção/estatística & dados numéricos , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Revisão da Utilização de Seguros , Seguro Saúde/organização & administração , Seguro Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Teste de Papanicolaou/estatística & dados numéricos , Patient Protection and Affordable Care Act , Serviços de Saúde Reprodutiva/economia , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Saúde Sexual/economia , Saúde Sexual/estatística & dados numéricos , Estados Unidos , Serviços de Saúde da Mulher/economia , Serviços de Saúde da Mulher/estatística & dados numéricos , Adulto Jovem
17.
Pan Afr Med J ; 35(Suppl 2): 143, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193958

RESUMO

Zimbabwe reported its first case of COVID-19 on 20 March 2020, and since then the number has increased to over 4000. To contain the spread of the causative SARS-CoV-2 and prepare the healthcare system, public health interventions, including lockdowns, were imposed on 30 March 2020. These resulted in disruptions in healthcare provision, and movement of people and supply chains. There have been resultant delays in seeking and accessing healthcare by the patients. Additionally, disruption of essential health services in the areas of maternal and child health, sexual and reproductive health services, care for chronic conditions and access to oncological and other specialist services has occurred. Thus, there may be avoidable excess morbidity and mortality from non-COVID-19 causes that is not justifiable by the current local COVID-19 burden. Measures to restore normalcy to essential health services provision as guided by the World Health Organisation and other bodies needs to be considered and implemented urgently, to avoid preventable loss of life and excess morbidity. Adequate infection prevention and control measures must be put in place to ensure continuity of essential services whilst protecting healthcare workers and patients from contracting COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Assistência à Saúde , Pandemias , Pneumonia Viral/epidemiologia , Doença Crônica/epidemiologia , Controle de Doenças Transmissíveis/organização & administração , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/prevenção & controle , Guias como Assunto , Recursos em Saúde/provisão & distribução , Acesso aos Serviços de Saúde , Humanos , Pessoas sem Cobertura de Seguro de Saúde , Medicina , Modelos Teóricos , Mortalidade , Neoplasias/terapia , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/prevenção & controle , Serviços de Saúde Reprodutiva/provisão & distribução , Organização Mundial da Saúde , Zimbábue/epidemiologia
18.
Lancet HIV ; 7(10): e711-e720, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33010243

RESUMO

Despite a large and growing body of literature on sexual and reproductive health (SRH) and HIV integration, the drivers of integration of SRH and HIV services, from a health systems perspective, are not well understood. These drivers include complex so-called hardware (structural and resource) and software (values and norms, and human relations and interactions) factors. Two groups of software factors emerge as essential enablers of effective integration of SRH and HIV services that often interact with systems hardware: (1) leadership, management, and governance processes and (2) provider motivation, agency, and relationships. Evidence suggests the potential for software elements that are essential enablers to overcome some of the obstacles posed by the non-integration of health system hardware elements (eg, financing, guidelines, and commodity supplies). These enabling factors include flexible decision making, inclusive management, and support in motivating frontline staff who can work with agency as a team. Improved software, even within constrained hardware (especially in low-income and middle-income countries), can directly contribute to improved SRH and HIV service delivery.


Assuntos
Prestação Integrada de Cuidados de Saúde , Infecções por HIV/epidemiologia , Serviços de Saúde Reprodutiva , Saúde Sexual , África ao Sul do Saara/epidemiologia , Tomada de Decisões , Análise Fatorial , Pessoal de Saúde , Humanos , Vigilância em Saúde Pública , Responsabilidade Social
19.
PLoS One ; 15(10): e0238585, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33044966

RESUMO

BACKGROUND: There is evidence that persons with disabilities often encounter grave barriers when accessing sexual and reproductive health services. To the best of our knowledge, however, no systematic review has been conducted to pull together these pieces of research evidence for us to understand the nature, magnitude and extent of these barriers in different settings in sub-Saharan Africa. We do not yet have a good understanding of the strength/quality of the evidence that exist on the barriers persons with disabilities face when accessing sexual and reproductive health services in sub-Saharan Africa. We therefore conducted a systematic review to examine the barriers persons with disabilities face in accessing sexual and reproductive health services in sub-Saharan Africa. METHODS: A systematic review was conducted using PRISMA guidelines (PROSPEROO protocol registration number: CRD42017074843). An electronic search was conducted in Medline, EMBASE, CINAHL, PsycINFO, and Web of Science from 2001 to 2020. Manual search of reference list was also conducted. Studies were included if they reported on barriers persons with disability face in accessing sexual and reproductive health services. The Critical Appraisal Skills Programme and Centre for Evidence Based Management (CEBMa) appraisal tools were used to assess methodological quality of eligible studies. FINDINGS: A total of 1061 studies were identified. Only 26 studies covering 12 sub-Saharan African countries were eligible for analysis. A total of 33 specific barriers including inaccessible physical health infrastructure and stigma and discrimination were identified. These barriers were further categorised into five levels: broader national level barriers; healthcare system/institutional barriers; individual level barriers; community level barriers; and economic barriers. CONCLUSION: Persons with disabilities face a myriad of demand and supply side barriers to accessing sexual and reproductive healthcare in sub-Saharan Africa. Multilevel interventions are urgently needed to address these barriers.


Assuntos
Pessoas com Deficiência , Acesso aos Serviços de Saúde , Serviços de Saúde Reprodutiva , Adolescente , Adulto , África ao Sul do Saara , Feminino , Humanos , Masculino , Adulto Jovem
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